New study reveals the surprising volume of mental health cases in primary care
An analysis of Norway’s primary healthcare records revealed that 12% of patient encounters between 2006 and 2019 were for mental health conditions. This is comparable to the volume of primary care encounters for infections, cardiovascular, or respiratory conditions. The research was published in Nature Mental Health.
Primary healthcare serves as the first point of contact for individuals within the healthcare system. Primary care physicians treat a wide range of health conditions, both acute and chronic. They also provide preventive care, vaccinations, health education, and early disease detection. By addressing most health needs close to where people live and work, primary healthcare reduces the burden on specialized and emergency services.
It is also the first point of contact for mental health disorders. Despite this, many primary care physicians feel ill-equipped to handle these conditions and often refer patients to psychiatric services. However, in many countries, psychiatric care is provided exclusively through secondary and tertiary healthcare, which can be less accessible. As a result, primary care physicians are often expected to provide at least some level of mental health care, particularly for mild mental health issues.
Study author Avshalom Caspi and his colleagues aimed to explore how frequently mental health conditions appear in primary healthcare. They note that while mental health conditions are rising globally, effective treatment coverage remains low. Strengthening the ability of primary care physicians to address mental health issues may be one way to improve the situation.
The researchers analyzed Norway’s primary healthcare records, an extensive dataset containing information on primary care encounters for 4,875,722 individuals born in Norway between 1905 and 2017. All residents of Norway are assigned a primary care physician, and access to specialist care typically requires a referral.
The work of primary care physicians in Norway is funded by the Norwegian Health Economics Administration. To receive payment, physicians must report at least one primary diagnosis or reason for each patient visit. This requirement makes it highly likely that all patient encounters and diagnoses are accurately recorded. Caspi and his team analyzed these diagnoses for patient visits reported between 2006 and 2019.
The results showed that 47% of registered users sought primary care for a mental health condition during the study period. These individuals experienced a wide range of psychological difficulties. For children, the most common reasons for visits were sleep disturbances, continence issues, and attention-deficit/hyperactivity disorder (ADHD). Younger and middle-aged adults most often sought care for depression, while older adults most frequently reported memory difficulties and sleep disturbances.
Mental health conditions accounted for just under 12% of all patient encounters in primary care. The most common mental health conditions were depression (23.8%) and anxiety (14.1%), followed by sleep disturbances (12.1%), substance abuse (8.3%), acute stress reactions (7.1%), psychosis (6.9%), dementia/memory problems (5.4%), ADHD (3.8%), phobias/compulsive disorders (1.7%), developmental delays/learning problems (1.5%), PTSD (1.3%), and personality disorders (1.1%).
When compared to other medical conditions, the volume of mental health encounters was roughly equal to the number of visits for infections, cardiovascular conditions, and respiratory issues. Mental health encounters were also more frequent than visits for pain, injuries, metabolic issues, skin conditions, or urological and reproductive health concerns.
“These primary care physicians are the gatekeepers,” said Caspi, the Edward M. Arnett Professor of Psychology and Neuroscience at Duke University. “The primary care physician data allows us to actually see people at their first contact with the healthcare system.”
“This report underscores what has become increasingly evident in medicine: without targeted efforts to expand mental health services within the primary care setting, the medical system will not meet the mental health needs of those that it serves,” added Damon Tweedy, a professor of psychiatry and behavioral sciences at Duke Health, who was not involved in this study.
The study highlights the significant proportion of patient encounters related to mental health within primary healthcare. However, while the findings are based on an exhaustive record database, they pertain specifically to Norway. Results in other countries may differ.
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